Tubal ligation
| Tubal ligation / Tubectomy | |
|---|---|
| Background | |
| Birth control type | Sterilization |
| First use | 1930 |
| Failure rates (first year) | |
| Perfect use | 0.5% |
| Typical use | 0.5% |
| Usage | |
| Duration effect | Permanent |
| Reversibility | Sometimes |
| User reminders | None |
| Clinic review | None |
| Advantages and disadvantages | |
| STD protection | No |
| Risks | Operative and postoperative complications. |
Tubal ligation or tubectomy (also known as having one's "tubes tied" (ligation)) is a surgical procedure for sterilization in which a woman's fallopian tubes are clamped and blocked, or severed and sealed, either method of which prevents eggs from reaching the uterus for fertilization. Tubal ligation is considered a permanent method of sterilization and birth control.
Procedure
Tubal ligation is considered major surgery requiring the patient to undergo general anesthesia. It is advised that women should not undergo this surgery if they currently have or have had a history of bladder cancer. After the anesthesia takes effect, a surgeon will make a small incision at each side of, but just below the navel in order to gain access to each of the 2 fallopian tubes. With traditional tubal ligation, the surgeon severs the tubes, and then ties (ligates) them off thereby preventing the travel of eggs to the uterus. Other methods include using clips or rings to clamp them shut, or severing and cauterizing them. Tubal ligation is usually done in a hospital operating-room setting.
The corresponding male surgical sterilization procedure known as Vasectomy is considered minor surgery done with local anesthesia and typically done in an out-patient setting.
Effectiveness
A tubal ligation is approximately 99% effective in the first year following the procedure. In the following years the effectiveness may be reduced slightly since the fallopian tubes can, in some cases, reform or reconnect which can cause unwanted pregnancy. Method failure is difficult to detect, except by subsequent pregnancy, unlike with vasectomy or IUD.
Of those failures, 15-20% are likely to be ectopic.[1] 84% of those failures occurred a year or more after sterilization. According to one study, approximately 5% of women who have had tubal ligation will have a failure due to ectopic pregnancy. Time seems to be a factor as the risk of failure increases after 1 or more years post-surgery. The risk of ectopic pregnancy is 12.5% for women who have had tubal ligation, which is a greater risk than for those who have not had the surgery. Recanalization or formation of tuboperitoneal fistulas occur, the openings of which are large enough for passage of sperm but too small to allow an ovum to push through, resulting in fertilization/implantation in the distal tubal segment.
Two economic studies suggest that laparoscopic bilateral tubal ligation could be less cost-effective than the Essure procedure, which uses a special type of fiber to induce a benign fibrotic reaction.[2]
Tubal ligation Methods
Bipolar Coagulation The most popular method of laparoscopic female sterilization, this method uses electrical current to cauterize sections of the fallopian tube. Depending on the number of sites coagulated, tube damage is typically only 2 or 3 centimeters in length and pregnancy rates after reversing this procedure are about 70%.
Fimbriectomy By removing a portion of the fallopia n tube closest to the ovary, fimbriectomy eliminates the ovary’s ability to capture eggs and transfer them to the ovary. Reversing this procedure involves opening the remaining fallopian tube and folding out the inner tubal lining so that egg capture is again possible. This procedure has the lowest success rates and repair is therefore not recommended. In vitro fertilization is usually the preferred treatment in these cases.
Irving Procedure This procedure calls for placing two ligatures (sutures) around the fallopian tube and removing the segment of tubing between the ligatures. Then to complete the procedure, the ends of the fallopian tubes are connected to the back of the uterus and the connective tissue respectively. Fortunately, this procedure usually leaves two healthy fallopian tube sections and a pregnancy rate of around 70% on average.
Monopolar Coagulation Less common than Bipolar Coagulation, Monopolar Coagulation uses electrical current to cauterize the tube together, but also allows radiating current to further damage the tubes as it spreads from the coagulation site. Many cases involve a cutting of the tubes after the procedure. Due to the fallopian tube damage from this procedure, pregnancy rates drop to approximately 45%. However if tubal length is still greater than 5 centimeters, then a 70% pregnancy success rate can be achieved.
Tubal Clip The tubal clip or Hulka Clip technique involves the application of a permanent clip onto the fallopian tube. Once applied and fastened, the clip disallows transference of eggs to the ovary. Reversal and pregnancy success is best with this procedure and can be as high as 85%.
Tubal Ring The silastic band or tubal ring method involves a doubling over of the fallopian tubes and application of a silastic band to the tube. Pregnancy success rates can also be very high with this method if only a small portion of the tube is damaged by the rings.
Pomeroy Tubal Ligation In this method of tubal ligation, a loop of tube is “strangled” with a suture. Usually, the loop is cut and the ends cauterized or “burned“. This type of tubal ligation is often referred to as cut, tied, and burned. These are usually very good for reversal. The fact that the ends are burned doesn’t matter because that part is going to be lost anyway during the tubal reversal.
Essure Tubal Ligation In this method of tubal ligation, two small metal and fiber coils are placed in the fallopian tubes. After insertion, scar tissue forms around the coils, blocking off the fallopian tubes and preventing sperm from reaching the egg.
Adiana Tubal Ligation In this method of tubal ligation, two small silicone pieces that are placed in the fallopian tubes. During the procedure, your health care provider heats a small portion of each fallopian tube and then inserts a tiny piece of silicone into each tube. After the procedure, scar tissue forms around the silicone inserts, blocking off the fallopian tubes and preventing sperm from reaching the egg.[3]
Reversal
Generally tubal ligation procedures are done with the intention to be permanent. Tubal reversal is microsurgery to repair the fallopian tube after a tubal ligation procedure.
Usually there are two remaining fallopian tube segments—the proximal tubal segment that emerges from the uterus and the distal tubal segment that ends with the fimbria next to the ovary. The procedure that connects these separated parts of the fallopian tube is called tubal reversal or microsurgical tubotubal anastomosis.
In a small percentage of cases, a tubal ligation procedure leaves only the distal portion of the fallopian tube and no proximal tubal opening into the uterus. This may occur when monopolar tubal coagulation has been applied to the isthmic segment of the fallopian tube as it emerges from the uterus. In this situation, a new opening can be created through the uterine muscle and the remaining tubal segment inserted into the uterine cavity. This microsurgical procedure is called tubal implantation, tubouterine implantation, or uterotubal implantation.
Tubal reversal, if done by a specialist microsurgeon, has a high success rate and few complications. Successful repair of the fallopian tubes is now possible in 98% of women who have had a tubal ligation, regardless of the type of sterilization procedure.[citation needed]
In vitro fertilization may overcome fertility problems in patients not suited to a tubal reversal.
Side effects
A 1998 review of over 200 articles in the English literature showed that evidence of a post-tubal sterilization syndrome (abnormal bleeding and/or pain, changes in sexual behavior and emotional health, increased premenstrual distress) was inconclusive for women over 30 years of age. The risk for women 20–29 years of age with pre-existing histories of menstrual dysfunction may be increased, "although they do not appear to undergo significant hormonal changes".[4] A 1993 study done in Japan found the symptoms of the post-tubal ligation syndrome to be mild, and simple symptomatic treatment to be sufficient in most cases.[5]
Prevalence
Worldwide, female sterilization is used by 33% of married women using contraception,[6] making it the most common contraceptive method.[7] As of June 2010, there is a recent decline of tubal ligation procedures in the United States after two decades of stable rates, possibly explained by an improved access to a wide range of highly effective reversible contraceptives.[8]
Advantages and disadvantages
Tubal ligation is an abdominal surgery. One study found that postoperative complications from tubal ligation are more likely than with vasectomy and more costly.[9] However, this study did not consider post-vasectomy pain syndrome. In industrialized nations, mortality is 4 per 100,000 tubal ligations, versus 0.1 per 100,000 vasectomies.[10]
Tubal ligation has a larger initial cost than other contraceptive methods. It may take more than a decade of use for tubal ligation to become as cost-effective as other highly effective, long term methods like IUD or implant. Continued method costs or costs from unintended pregnancies make many other methods as or more costly than tubal ligation if used for several years.[9] The cost of tubal ligation is reduced if it is performed during a cesarean section, since the tubes are already exposed during the laparotomy.
Tubal ligation may reduce the risk of ovarian cancer, with some studies estimating the relative risk at 0.66 for epithelial types, 0.40 for endometrioid types and 0.73 for serous types.[11]
Tourism
Medical tourism is likely to be used for expensive and more complicated surgeries; however tubal ligation is on the list of available procedures.[clarification needed] Women opting for tubal ligation would likely combine their convalesce in/with a vacation-type setting. There are a large number of overseas hospitals whose websites list tubal ligation as one of their qualified surgical procedures. Medical tourism is gaining popularity (especially with higher-cost surgeries) as the overall cost of care in developing countries can provide a combination of high-tech medical care at a cost that allows for more enjoyable recovery in a vacation-type setting. Medical tourism is somewhat controversial, and has come under the scrutiny of some governments the concerns of which include quality of care, follow-up and post-operative care.[12]
Forced Sterilization of People of Color
The discourse around low-income communities of color is a negative one in the field of public health and the law. Many institutions view, specifically women of color, as reproductive menaces. The stereotypes of people of color as being criminals, health risks, and economic burdens affect the way the government and institutions view their reproductive rights. [13]
Communities of color often come from low resourced backgrounds that lack, more importantly, the education needed to understand the health care system in the discourse of the criminalization of their bodies.[14] Having these types of poor and uneducated background, the criminal justice system strives to take control of women of color’s reproductive rights by ordering them to become sterilized through tubal ligation in order to prevent women of color from creating more brown bodies, which the system assumes, that will perpetuate this cycle of crime and poverty. “Sterilization should not be used as a mechanism to rid the United States of individuals society deems ‘defective.’” [15]
In the specific case of Latina women, hospitals with the guidance of the criminal justice system, would be tricked into signing consent to sterilization forms in the most chaotic situations (Madrigal v. Quilligan). During emergency surgeries and labor, Latinas would be tricked into signing these consent forms by being told they are for anesthetics. On top of that, these forms are in English which many of these Latinas cannot understand. Some hospitals would deny service to the, as Peal calls them, “undesirables” unless they submitted to sterilization through tubal ligation. [16]
References
- ^ Shah JP, Parulekar SV, Hinduja IN (January 1991). "Ectopic pregnancy after tubal sterilization". J Postgrad Med 37 (1): 17–20. PMID 1941685.
- ^ Hurskainen, R.; Hovi, S.; Gissler, M.; Grahn, R.; Kukkonen-Harjula, K.; Nord-Saari, M.; Mäkelä, M. (2010). "Hysteroscopic tubal sterilization: a systematic review of the Essure system". Fertility and Sterility 94 (1): 16–19. doi:10.1016/j.fertnstert.2009.02.080. PMID 19409549.
- ^ http://www.reversemytubes.com/tubal-ligation-procedures-raleigh/
- ^ Gentile GP, Kaufman SC, Helbig DW; Gentile GP, Kaufman SC, Helbig DW (Feb 1998). "Is there any evidence for a post-tubal sterilization syndrome?". Fertility and Sterility 69 (2): 179–186. PMID 9496325.
- ^ Satoh K, Osada H; Satoh K, Osada H. (1993). "[Post-tubal ligation syndrome] [Article in Japanese]". Ryōikibetsu shōkōgun shirīzu (1): 772–3. PMID 7757737.
- ^ Family Planning Worldwide: 2008 Data Sheet (PDF). Population Reference Bureau. 2008. Retrieved 2008-06-27. Data from surveys 1997-2007.
- ^ World Health Organization (2002). "The intrauterine device (IUD)-worth singing about". Progress in Reproductive Health Research (60): 1–8.
- ^ Chan LM, Westhoff CL (June 2010). "Tubal sterilization trends in the United States". Fertil. Steril. 94 (1): 1–6. doi:10.1016/j.fertnstert.2010.03.029. PMID 20497790.
- ^ a b James Trusell, et al. (April 1995). "Economic value of contraception" (PDF). American Journal of Public Health 85 (4): 494–503. doi:10.2105/AJPH.85.4.494. PMC 1615115. PMID 7702112.
- ^ Ninaad S. Awsare, Jai Krishnan, Greg B. Boustead, Damian C. Hanbury, and Thomas A. McNicholas (2005). "Complications of vasectomy.". Ann R Coll Surg Engl 87 (6): 406–410. doi:10.1308/003588405X71054. PMC 1964127. PMID 16263006.
- ^ Cibula, D.; Widschwendter, M.; Majek, O.; Dusek, L. (2010). "Tubal ligation and the risk of ovarian cancer: review and meta-analysis". Human Reproduction Update 17 (1): 55. doi:10.1093/humupd/dmq030. PMID 20634209.
- ^ Lunt, Neil; Carrera, Percivil (2010). "Medical tourism: Assessing the evidence on treatment abroad". Maturitas 66 (1): 27–32. doi:10.1016/j.maturitas.2010.01.017. PMID 20185254.
- ^ Peal, Tiesha Rashon. "Continuing Sterilization of Undesirables in America, The." Rutgers Race & L. Rev. 6 (2004).
- ^ Peal, Tiesha Rashon. "Continuing Sterilization of Undesirables in America, The." Rutgers Race & L. Rev. 6 (2004).
- ^ Peal, Tiesha Rashon. "Continuing Sterilization of Undesirables in America, The." Rutgers Race & L. Rev. 6 (2004).
- ^ Peal, Tiesha Rashon. "Continuing Sterilization of Undesirables in America, The." Rutgers Race & L. Rev. 6 (2004).
External links
 |
Wikimedia Commons has media related to: Contraception |
|
||||||||||||||||||||||||||||||||||||||||||
